Impact of systemic corticosteroids on the clinical course and outcomes of patients with severe community-acquired pneumonia: a cohort study

Introduction: Our aim was to evaluate the impact of corticosteroids on clinical course and outcomes ofpatients with severe community-acquired pneumonia (CAP) requiring invasive mechanical ventilation.Methods: This was a cohort study of patients with severe CAP from 2 intensive care units in tertiaryhospitals in Brazil and Portugal.Results: A total of 111 patients were included (median age, 69 years; 56% men; 34% hospitalmortality). Corticosteroids were prescribed in 61 (55%) patients. Main indications for their use werebronchospasm (52.5%) and septic shock (36%). Mortality rate of patients treated with and withoutcorticosteroids was comparable (29.5% vs 32%, P = .837). No significant differences were observed onclinical course from day 1 to day 7 as assessed by the Sequential Organ Failure Assessment score (P =.95). Furthermore, C-reactive protein declined similarly in both groups (P = .147). In a multivariateanalysis, mortality was associated with older age and higher Acute Physiology and Chronic Health Evaluation II score.(AU)

[QTc interval and traditional risk factors to atherosclerotic disease in patients with type 1 diabetes]. / Intervalo QT corrigido e fatores de risco tradicionais para doença aterosclerótica em pacientes com diabetes tipo 1.

To evaluate the QTc interval and its relation with clinical, laboratorial variables and LDL susceptibility to in vitro oxidation in patients with type 1 DM, we studied 40 diabetics and 33 non diabetics with 24.83 +/- 10.21 and 23.51 +/- 7.28 years old, respectively matched by sex, age and body mass index (BMI). We evaluated metabolic control, A and B apolipoproteins, LDL oxidation coefficient for spectrophotometry and electrocardiogram (ECG). Interval QTc was calculated by the Bazetts formula. There was no difference in QTc between diabetic and non diabetic groups (394.43 +/- 19.98 ms versus 401.31 +/- 17.83 ms; p = 0.2065). Five diabetics showed increased QTc (396.76 +/- 14.63 ms versus 429.75 +/- 1.89 ms; p < 0.001) and lesser A apolipoprotein levels than rest of diabetic group (74.60 +/- 25.42 mg/dL versus 113.64 +/- 29.79 mg/dL; p = 0,011). In pooled sample, there was correlation between QTc and BMI (rho = -0.288; p = 0.045), pot-prandial glycemia (rho = 0.357; p = 0.016) and 3 h oxidation coefficient (OxC3h) (r = -0.293; p = 0.039). In diabetics, there was correlation between QTc and triglycerides (rho = -0.420; p = 0.023) and OxC3h (r = -0.427; p = 0.021). Although there was no difference between QTc of diabetics and the non diabetics subjects studied, there was correlation with risk factors for the atherosclerotic disease. Further studies are necessary to establish the real predictive value of QTc for this type of disease in the patients with type 1 DM.

The impact of coagulation parameters on the outcomes of patients with severe community-acquired pneumoniarequiring intensive care unit admission

Introduction: Coagulation abnormalities are frequent in patients with severe infections. However, thepredictive value of D-dimer and of the presence of associated coagulation derangements in severecommunity-acquired pneumonia (CAP) remains to be thoroughly evaluated. The aim of this study wasto investigate the predictive value of coagulation parameters in patients with severe CAP admitted to theintensive care unit.Methods: D-Dimer, antithrombin, International Society of Thrombosis and Hemostasis score, clinicalvariables, Sequential Organ Failure Assessment (SOFA), The Acute Physiology and Chronic HealthEvaluation II (APACHE II) and the CURB-65 score were measured in the first 24 hours. Results areshown as median (25%-75% interquartile range). The main outcome measure was hospital mortality.(AU)